Ahmad Taufik Jamil
Global pandemic of physical inactivity
WHAT IS THE CURRENT TREND OF PHYSICAL ACTIVITY?
While the health benefits of physical activity are well-established, the trend does not show any improvement, globally. Recently, the Lancet published an article on the current global trend of physical inactivity.
The study is based on data from 168 countries. For the first time, a complete description of global trend, regional and country level of physical inactivity was presented. The 2016 global insufficient physical activity level is 27.5 per cent. It is a pandemic of physical inactivity that occurs worldwide. The data shows no significant changes, compared to 2001, where insufficient physical activity level was 28.5 per cent. This is a 15-year gap, and no significant improvement is seen.
Furthermore, compared to data in 2010, it shows increase in physical inactivity level, from 23.3 per cent.
Globally, the data shows that women are less active with a more than eight per cent gap, compared to men. In some countries like Saudi Arabia, Iran and Iraq, the difference is more than 20 per cent.
Physical inactivity is highest in Latin America region with prevalence of 39.1 per cent. Looking at the trend from 2001, high-income western countries show increase of more than five per cent of physical inactivity. Four countries - Kuwait, American Samoa, Saudi Arabia and Iraq- have prevalence of more than 50 per cent. The highest prevalence of physical inactivity is in Kuwait (67 per cent).
In Malaysia, the prevalence of physical inactivity in 2016 is 38.8 per cent. According to the world ranking, we are at No.31, out of 168 countries, included in the study.
Malaysia now is no more in the top 10 list, as in 2008. However, in Southeast Asia, we are second, after Philippines (39.7 per cent). Since 2008, the prevalence of physical inactivity has improved remarkably from 61.4 per cent (2008) to 52.3 per cent (2010) and 38.8 per cent in 2016. However, our rate is still higher, compared to global physical inactivity rate.
We still suffer from a gender gap of physical inactivity. Men are still more active than women with an 8.2 per cent difference. A lot of things can be done to improve physical activity level, including transportation, household work, and occupational and recreational physical activity. Social and cultural issues need to be addressed too. Improving physical activity level among schoolchildren is also important.
WHAT HAS BEEN DONE, GLOBALLY AND LOCALLY, TO INCREASE PHYSICAL ACTIVITY LEVEL?
In 2013, the World Health Organisation endorsed a set of nine global voluntary targets to prevent and control non-communicable diseases. One of the targets is to reduce 10 per cent prevalence of insufficient physical activity by 2025.
In June 2018, WHO launched the Global Action Plan on Physical Activity 2018-2030. The target for the action plan is a 15 per cent relative reduction, using a baseline of 2016 data, in the global prevalence of physical inactivity by 2030. This means reducing the 27.5 per cent of the global prevalence in 2016 to 12.5 per cent in 2030.
Last month, WHO launched Actuve, a toolkit to help countries reduce the alarming levels of physical inactivity and further reduce non-communicable diseases. Its technical package is based on WHO’s Global Action Plan for Physical Activity 2018-2030, and aims to support countries to achieve the global target of reducing physical inactivity.
In our country, we have Garis Panduan Aktiviti Fizikal Kementerian Kesihatan Malaysia (Guide to Physical Activity by the Health Ministry of Malaysia), published last year. This month, we launched the National Strategic Plan on Active Living during WALK (When Active Living Kick), by the Prime Minister Tun Dr Mahathir Mohamad. During the launch, he suggested the government and private sectors to allocate 15 minutes office time for exercise to promote a healthy lifestyle.
We are still at an infancy in promoting physical activity to improve health and reduce non-communicable diseases. We hope that physical activity will become important agenda by the government in reducing non-communicable diseases.
DESPITE THE KNOWN PHYSICAL ACTIVITY BENEFIT, WHY DON’T MANY PEOPLE EXERCISE?
Many feel that the minimum amount of physical activity as recommended by WHO is too much to do. This is especially true for people with obesity, are severely de-conditioned or are suffering from chronic diseases.
In 2010, WHO recommended a minimum of 150 minutes of moderate intensity physical activity or 75 minutes of vigorous physical activity a week. I believe the focus should be to get inactive people to do some physical activity, rather than meeting to recommended minimum physical activity level.
A gradual increment of physical activity should be the core message to the public. Japan uses this approach - adding 10 minutes per day, gradually, over weeks or months, on current level of physical activity. Some exercise is better than no exercise, but of course, more is better than less.
A few studies show that some amount of physical activity, below the minimum recommended guideline, give significant benefits. A study by Wen et. al. in 2011 reported that 15 minutes of moderate physical activity per day (90 minutes/week), conferred 14 per cent risk reduction of all-cause of mortality.
Lee and his colleagues (2014) showed that running 51 minutes, 9.6km and one to two times will reduce mortality risk by 20 per cent. A similar amount of mortality reduction is also proved by Arem et al (2015) by doing 7.5 Metabolic Equivalent of Task (MET) hours per week (450 MET minutes/week) physical activity. These three studies showed that even if we are do small amount of physical activity, below the minimum recommendation, we will still get significant health benefits.
* An avid sportsman who believes in the healing powers of exercise, Assoc. Prof. Dr Ahmad Taufik Jamil is Universiti Teknologi MARA’s public health consultant and exercise physician. Reach him at atjamil@gmail.com